tbuckley/cabot-search huggingface dataset:
Abstract P580: Cannabis Use Among Young Females of Ages 15 to 35 Admitted for Heart Failure in the United States
Authors: Balkiranjit Kaur Dhillon, Shaheen Sombans, Kamleshun Ramphul, Renuka Verma, Osama A Rehman, Stephanie G Mejias, Yogeshwaree Ramphul, Sailaja Sanikommu, Fnu Arti, Petras Lohana, Nomesh Kumar
Journal: Circulation (2023)

Introduction: Cannabis legalization in many states has led to an increase in the substance’s usage among the younger population, prompting patients, physicians, and policy-makers to seek more information. This study uses the 2019 National Inpatient Sample (NIS) to compare patient characteristics, comorbidities, and the presence of certain cardiac arrhythmias among young females admitted with heart failure and using cannabis compared to those not using cannabis. Hypothesis: We assessed the hypothesis that cannabis use among young females aged 15-35 with heart failure is linked to an increased baseline cardiovascular risk and a higher chance of cardiac events during hospitalization for heart failure. Method: Females of ages 15 to 35 with a principal diagnosis of heart failure were pooled from the 2019 NIS. The usage of cannabis was also identified using recommendations from past studies. Different patient characteristics were compared via Chi-Square tests, and the presence and risk of cardiac arrhythmias were also studied via logistic models. Results: Among 7780 cases of heart failure identified in women between the ages of 15 to 35, 425 (5.5%) were cannabis users. The study showed that a larger proportion of cannabis users were racially classified as Blacks (67.5%) and Medicaid was the predominant insurer (57.6%). They also had a higher prevalence of smoking (74.1% vs. 35.2%, p&lt;0.01), hypertension (27.1% vs. 22.0%, p=0.014), and peripheral vascular disease (4.7% vs 2.0%, p&lt;0.01). However, non-users had a higher prevalence of obesity (29.4% vs. 40.9%, p&lt;0.01), diabetes mellitus (21.2% vs. 31.7%, p&lt;0.01), hyperlipidemia (11.8% vs. 16.2%, p=0.016), chronic pulmonary disease (16.5% vs. 23.8%, p&lt;0.01), arthropathies (4.7% vs. 11.5%, p&lt;0.01), and hypothyroidism (5.9% vs. 10.4%, p&lt;0.01). More cannabis users reported ventricular tachycardia (9.4% vs 5.5%, aOR 1.887, 95% confidence interval 1.272-2.798, p=0.002)) and paroxysmal atrial fibrillation (4.7% vs. 2.1%, aOR 1.926, 95% confidence interval 1.089-3.438, p=0.027) during their hospitalization. On the contrary, the length of stay (LOS) in the hospital was shorter for cannabis users compared to non-users (mean stay of 5.07 days vs. 5.86 days). Conclusion: While young female cannabis users with heart failure had a shorter hospitalization, they were more prone to report arrhythmic events such as ventricular tachycardia and paroxysmal atrial tachycardia. Although differences in baseline cardiovascular risk associations were noted among this population, further clinical and laboratory studies are encouraged to help understand the pathophysiologic mechanisms behind such differences.
Abstract P312: Mortality Analysis: The Long-Term Health Benefits of 50-Mile Ultra-Marathon Participation Outweighs the Risks, 1951-1979
Authors: Erin O'Donnell, Colin R Carriker, James M Smoliga
Journal: Circulation (2023)

Introduction: Aerobic exercise training yields numerous health benefits including a reduced risk of cardiovascular disease and improved overall health. However, there are concerns that “excessive” exercise can have delirious effects. For example, research reveals elevated cardiac injury biomarkers (i.e., cardiac troponins) following participation in ultra-marathon competitions (running races &gt;26.2 miles). However, the long-term clinical implications of ultra-marathon participation remains unknown. Hypothesis: The extreme cardiac stress of ultra-marathon running may lead to earlier death rates among the most elite participants. Methods: The 150 fastest finishers of 50-mile ultra-marathons from 1951-1979 were identified using the “Ultra Marathon Statistics” database (http://statistik.d-u-v.org/). Online search engines and databases were used to identify each runner’s birthdate and date of death (if deceased) or most recent date known to be alive. Kaplan Meier curves with median survival times were computed using the available data. Results: Data from 58 elite ultra-marathoners were identified with a high-level of confidence as confirmed by a minimum of two reviewers. Twenty-four of these athletes were deceased (median age of death = 73.0 years, interquartile range = 15.2 years, range = 36.0-98.7 years, median birthyear = 1936), and 34 were last known to be alive (median age = 75.7 years, IQR = 9.4 years, range = 62.0-88.8y, median birthyear = 1943). The median 50 mile finish time was identical for each group (5h 43min; pace of 6min 51.6 seconds per mile). The Kaplan Meier curve yielded a median survival time of 85.8 years (95% confidence interval = 80.8 to 90.7 years). Conclusion: The lifespan of elite ultra-marathon runners is greater than that of the general population. The long lifespans of elite athletes completing 50-mile races suggests the long-term health benefits of ultra-marathon participation outweigh the risks. Future research should investigate the mortality of elite athletes competing in longer ultra-marathons (e.g., 100M, 6-day races) to ascertain whether mortality rates differ from those training for and completing 50-mile races.
Abstract P466: Relationship Between Smoking and Sleep Duration Depends on Age
Authors: Suzanne B Gorovoy, Freda Patterson, Michael A Grandner
Journal: Circulation (2023)

Introduction: Smoking is a major cardiometabolic risk factor that is associated with worse sleep health, partially since nicotine is a stimulant. The present study examined the population-level association between habitual sleep duration and smoking, and whether this relationship may be stronger in younger adults. Methods: Data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) was used. Current smoking status of combustible cigarettes was self-reported (yes/no). Habitual sleep duration was reported in hours and categorized as &lt;=4, 5, 6, 7 (reference), 8, 9, and 10+ hours. Covariates included age group, sex, race/ethnicity, and education level. Population-weighted binary logistic regression with smoking as outcome and sleep duration as predictor, adjusted for covariates, was performed. A sleep-by-age interaction term was computed and analyses were stratified by age group. Results: In the complete BRFSS sample (N=375,422), compared to 7 hours, smoking was more likely among those sleeping &lt;=4 (OR=2.6, 95%CI [2.3,2.9]), 5 (OR=2.0, 95%CI [1.8,2.1]), 6 (OR=1.5, 95%CI [1.4,1.5]), 8 (OR=1.1, 95%CI [1.0,1.2]), 9 (OR=1.2, 95%CI [1.1,1.4]), and 10+ hours (OR=1.7, 95%CI [1.5,1.9]). A sleep-by-age interaction was significant (p=0.0002). Results of age-stratified analyses are reported in the Table. Overall, relationships differed by age, with sleep-related associations strongest in the youngest adults and generally weakening in older participants. Discussion: Smoking was associated with both short and long sleep durations, across all age groups. However, this depended on age, such that relationships were strongest in the youngest age groups. Future cardiometabolic health efforts in young adults should highlight this association. Table 1: Odds of Smoking as a Factor of Age and Sleep Duration
Abstract MP60: Prediabetes and Undiagnosed Diabetes Predisposing Women to Excess Risk of Cardiovascular Disease
Authors: Yilin Yoshida, Zhipeng Chen, Franck Mauvais-Jarvis
Journal: Circulation (2023)

Objective: Women with type 2 diabetes (T2DM) have a 25-50% higher risk of cardiovascular disease (CVD) than their men counterparts. The reasons for this sex disparity are incompletely understood. We sought to examine if pre-diabetes (preDM) and undiagnosed T2DM are associated with a greater magnitude of CVD risk in women than in men. Methods: We pooled CVD-free individuals (N=18,745) from the Atherosclerosis Risk in Communities, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. CVD outcomes included incident coronary heart disease (CHD) (myocardial infarction, CHD death, or cardiac procedures including percutaneous coronary interventions, bypass surgery, or coronary revascularization), stroke (ischemic or hemorrhagic stroke), and a composite atherosclerotic CVD (ASCVD) (any CHD condition or stroke). Multivariable Cox models examined the outcomes associated with preDM (fasting glucose [FG] 100-125 mg/dL or HbA1c 5.7-6.4%) or undiagnosed T2DM (FG ≥126 mg/dL or HbA1c ≥6.5% and without a DM diagnosis or anti-diabetes medication use) adjusted for age, race/ethnicity, education, BMI, blood pressure, total cholesterols, smoking, anti-hypertensive and lipid-lowering medications, and cohort indicator. An interaction term sex x preDM or undiagnosed DM was added to models to test the sex modifying effect. We consider p-interaction&lt;0.2 as significant. Results: During a median follow-up of 17 years, the adjusted model showed that preDM was significantly associated with a higher risk of CHD (Hazard ratio 1.09, 95%CI 1.04-1.14), stroke (1.08, 1.04-1.13), and ASCVD (1.09, 1.04-1.14) in women, but not in men (1.04, 0.99-1.1 for CHD, 1.03, 0.98-1.08 for stroke, and 1.03, 0.98-1.09 for ASCVD, respectively). Undiagnosed T2DM was significantly associated with the risk of CHD (1.27, 1.16-1.4 in women and 1.17, 1.05-1.3 in men), stroke (1.32, 1.21-1.45 in women and 1.2, 1.09-1.32 in men), and ASCVD (1.27, 1.16-1.4 in women and 1.15, 1.03-1.29 in men) in both sexes but with more pronounced effect in women (P-interactions ≤0.11). In racial-stratified analysis, a higher magnitude of CVD risk associated with preDM or undiagnosed DM was also found in non-Hispanic (NH) white women and NH-black women than in their men counterparts. Conclusions: PreDM and undiagnosed DM predispose women to excess CVD risk, possibly due to women’s higher susceptibility to metabolic dysfunction at a lower glucose level and the prolonged unmanaged time for risk factors relative to men. T2DM screening and risk factor control should be enhanced in both sexes to reduce future CVD risk, particularly in women.
Abstract P601: Death Certificate-Based Screening Methodology is an Efficient and Accurate Methodology for Identifying Sudden Death Victims
Authors: Gabriella Day, Andrew Cesmat, Susan Keen, Alia Capone, Ross J Simpson
Journal: Circulation (2023)

Introduction: Out-of-hospital sudden death accounts for over 10% of all deaths among working age adults. Traditional methods of identifying victims by screening Emergency Medical Services (EMS) reports and clinical adjudication are labor intensive. We hypothesize death certificates may provide efficient and reliable information to identify victims of sudden death. This study aims to compare a death certificate-based sudden death screening algorithm to a more time-intensive EMS-screened and cardiologist-adjudicated sudden death method. Methods: Death certificates from four North Carolina counties (Guilford, Mecklenburg, Surry, Wake) were screened by written protocol. Cases were excluded if age under 18 or over 64, hospital death, non-free living, or non-natural cause of death (overdose, gunshot wound, suicide, drowning, cancer, traumatic death without evidence of coronary disease). Census tract data was determined from victim home address. These 2013 death certificate cases were compared to our preexisting dataset of EMS-screened, cardiologist-adjudicated cases identified in Wake County 2013-2015. Demographic data was compared between datasets using Wilcoxon rank sum test for continuous variables and Fisher’s exact test for categorical variables. Results: Death certificate cases included 518 victims and EMS-screened/cardiologist-adjudicated cases included 399 victims. There were 99 overlapping cases in both datasets which were excluded from this comparative analysis. Demographic and social data were similar in the two groups (Table 1). Conclusion: Like previous methods have shown, sudden death occurs predominantly among unmarried individuals and is more common among black race and male sex. Death certificate screening methods are sufficient to identify sudden death victims to allow for efficient, population-based assessment of the epidemiology of sudden death. These methods may allow for identification of high-risk communities to facilitate intervention to reduce the incidence of sudden death.
Abstract P584: The Impact of Multimorbidity and Functional Limitation on Mental Health and Quality of Life Among Patients With Heart Failure
Authors: Sheila M Manemann, Erinn M Hade, Irina V Haller, Benjamin D Horne, Catherine P Benziger, Veronique L Roger, Susan A Weston, Jill M Killian, Alanna M Chamberlain
Journal: Circulation (2023)

Background: Multimorbidity (MM) and functional limitation (FL) are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on mental health and quality of life in patients with HF is not well understood. Methods: Patients aged ≥ 30 years with 2 or more HF diagnostic codes and 1 or more HF-related prescription drugs from four US institutions were mailed a survey to measure functional status (activities of daily living [ADLs]), quality of life and mental health (PROMIS-29 Health Profile) and social support (PROMIS Informational Support, Instrumental Support, and Social Isolation Short Forms). The sampling frame was restricted to patients with a first ever-diagnosis of HF on or after 1/1/2013 at 1 of the participating sites and on or after 1/1/2015 for the other 3 participating sites. A total of 3330 patients returned the survey (response rate 35%); among these, 3020 completed the questions of interest for this analysis and were retained. MM was defined as the presence of ≥ 2 non-cardiovascular comorbidities, and FL was defined as reporting any limitation in at least 1 of 8 ADLs. Patients were categorized into 4 groups by MM (Yes/No) and FL (Yes/No). We dichotomized the subscale scores of the PROMIS-29 at the median and calculated odd ratios for the 4 MM/FL groups. Results: Among 3020 patients with HF (45% female; mean age 73±12 years), 29% had neither MM or FL, 24% had MM only, 22% had FL only, and 25% had both. After adjustment, having both MM and FL or only FL was associated with increased odds of higher anxiety, depression, fatigue, sleep, and pain scores compared to having neither (Figure); having MM only was associated with a higher pain score. Conclusions: Patients with both FL and MM and only FL have similar odds of poor mental health and quality of life scores, underscoring the importance of the role that FL plays in outcomes in patients with HF.
Abstract P257: Self-Perception of Mental and Physical Health Are Significant Predictors of Activities of Daily Living
Authors: Chaitali Dagli, Chih-Hung Chang, Robin Hattori, Mersha Wubie, Lisa T Connor
Journal: Circulation (2023)

Background: Stroke is a leading cause of long-term disability and death worldwide. Stroke results in impaired physical, psychological, and social functions. This study examined the extent to which self-perception of physical and mental health, conditions manageable by behavioral intervention (MBI), and medical conditions contribute to activities of daily living (ADL) performance post-stroke among adults aged 65 and above. Methods: Data from the 2017 Medicare Health Outcomes Survey Cohort 19 were analyzed. The outcome variable was defined as, being able to independently perform basic ADL such as bathing, dressing, eating, getting in and out of the chair, walking, and using the toilet. Stepwise binary logistic regression was used to identify risk factors that predict overall ADL performance. Results: A total of 9,531 older adults with stroke were included in the study, 56.97% of whom were females. Overall, 58.6% had some difficulty or were unable to perform ADLs post-stroke. In the final model, self-perception of physical (OR=0.89, 95% CI=0.883, 0.896) and mental (OR=0.961, 95% CI=0.954, 0.968) health and older (74+) age (OR=1.7, 95% CI=1.452,1.895) were associated with difficulty in self-perception of ADL. A 12.2% increase in explained variance after adding medical conditions such as diabetes, hypertension, cancer, etc. to demographic factors; a 13.6% increment in explained variance after adding conditions MBI such as obesity, smoking, pain, etc.; and a 10.5% increment after adding self-perception of mental and physical health was obtained. The final model explained 39.4% of the total variance in the self-perception of ADL. Conclusion: Not only conditions manageable by behavior interventions, and medical conditions predict performance, but self-perceptions of mental and physical health have an impact on ADL. The significant association between self-perception and ADL found in this study signals the need for new avenues for interventions for persons with stroke with respect to their ability to perform self-care activities. These findings can inform future work that identifies and addresses psychosocial and behavioral risk factors that contribute to ADL.
Abstract P309: Biomarkers of Mitochondrial Dysfunction and Inflammaging in Older Adults and Blood Pressure Variability
Authors: Leonardo Bencivenga, Mathilde Strumia, Yves Rolland, Sandrine Andrieu, Bruno Vellas, Philipe de Souto Barreto, Laure Rouch
Journal: Circulation (2023)

Background: Most physiopathological mechanisms underlying Blood Pressure (BP) Variability (BPV) are implicated in aging. Vascular aging is associated with chronic low-grade inflammation occurring in late life, known as "inflammaging", and the hallmark “mitochondrial dysfunction” due to age-related stress. We aimed to determine whether plasma levels of the pleiotropic stress-related mitokine Growth/Differentiation Factor 15 (GDF-15) and two inflammatory biomarkers, Interleukin 6 (IL-6) and Tumor necrosis factor receptor 1 (TNFR-1), are associated with visit-to-visit BPV in a population of community-dwelling older adults. Methods: The study population consisted of 1,096 community-dwelling participants [median age 75 (72-78) years; 699 females, 63.7%] aged ≥70 years from the MAPT study. Plasma blood sample was collected 12 months after enrolment and BP was assessed up to seven times over a 4-year period. Systolic (SBPV) and diastolic BPV (DBPV) were determined through several indicators taking into account BP change over time, the order of measurements and formulas independent of mean BP levels. Results: Higher values of GDF-15 were significantly associated with increased SBPV (all indicators) after adjustment for relevant covariates [adjusted 1-SD increase in GDF-15: β (SE)= 0.07 (0.04), p&lt; 0.044, for Coefficient of Variation%]. GDF-15 levels were not associated with DBPV. No significant associations were found between IL-6 and BPV, whereas TNFR1 was only partially related to DBPV. Conclusion: Unlike inflammation biomarkers, higher GDF-15 levels were associated with greater SBPV. Our findings support the age-related process of mitochondrial dysfunction underlying BP instability, suggesting that BPV might be a potential marker of aging.
Abstract P545: Association Between Inpatient Glycemic Variability and COVID-19 Mortality - A Prospective Study
Authors: Cristina P Baena, Rebecca B Stocco, Julia d Lopes, Marcos R Pereira, Marcia Olandoski, Henrique Demeneck, Salma A Parolin
Journal: Circulation (2023)

Introduction: The benefit of glycemic control was demonstrated in previous studies for the treatment of inpatients with acute infections, regardless of the diagnosis of diabetes mellitus (DM). DM is considered an important risk factor for poor outcomes in hospitalized patients. Hypothesis: This study aimed to determine the association between glycemic variability and mortality in COVID-19 hospitalized patients. Methods: This prospective study analyzed the data from patients with confirmed COVID-19, admitted to a private reference hospital, from February 2020 until July 2021 aged &gt; 18 years. They were stratified according to the glycemic variability measured by coefficient of variation (CV) and standard deviation (SD). A logistic regression model was used to determine the association of poor glycemic variability and mortality in diabetic and non-diabetic hospitalized patients with COVID-19. Results: Data from 628 patients with confirmed COVID-19 and point-of-care (POC) glucose testing was used to measure SD and CV. The cut-off points for SD ≥ 44.7 and CV ≥ 27.5% was defined using the point of a ROC curve that predicted higher risk of death. Patients were stratified in groups for each used metric: SD &lt; 44.7(n=357) and ≥ 44.7(n=271); CV &lt;27.5% (n=318) and ≥ 27.5% (n=310). When controlling for multiple variables (age, sex, comorbidities and in-hospital corticoid use) there was a significant association between high VG and mortality (SD: OR 3.01 and CV: OR 2.45) (all p values &lt; 0.05). When they were stratified as with previous DM condition and without-DM, after adjusted variables, the risk of mortality was higher in patients with uncontrolled VG, regardless the presence of DM (p&lt;0.001). Conclusion: In conclusion, our data suggest that a grate glycemic variability is associated with higher mortality in inpatients with COVID-19 regardless of diabetes status. Efforts should be made to improve the glycemic control of these patients.